Stroke - Cardioembolic
Afib
Warfarin
-Start, 5 mg daily, daily INR (chx 72h)
-Discuss w/ pt diet & goals
LAAL and LAAO
Considerations
- stroke due to Afib after full anticoagulation
- stroke due to Afib and cannot use anticoagulation
LAAO and LAAL
LAAO
-Watchman and amulet
LAAL
-Lariat and sierra
Trials
-CHAMPION-AF: LAAO is noninferior to DOAC in AC-eligible AF pts
>In contrast: CLOSURE-AF; LAA closure is inferior to best medical therapy (predominantly DOAC) in a high-risk population
Pitfalls
-If STEMI & stroke, stroke 2/2 myocardial stunning (no Afib)→ NO AC
-If start AC, no need for heparin ppx